Monday, May 25, 2015

AAC needs to be approached with the idea that the user does, indeed, have his own thoughts he wants to express – and that these thoughts are valuable. It needs to be approached with the idea that the AAC user can be competent.

According to the American Speech and Hearing Association (ASHA), the most effective approach to augmentative communication is one that allows for spontaneous novel utterance generation (SNUG). SNUG allows the AAC user to say whatever he wants whenever he wants.

In order to maximize SNUG, vocabulary selection is of prime importance. And once we have chosen the vocabulary, we need to consider how to organize it.

Language based systems provide the AAC user the opportunity to say something new or self-selected, and allow the user the flexibility to communicate his own unique thoughts. The question then is how to organize those words in the system.

One answer to that question is to use core vocabulary. Core vocabulary AAC organization provides an organized vocabulary set the users can use across environments and contexts, and that intervention can target in any context.

Core vocabulary is comprised of high frequency words that are multi-purpose and versatile, and is independent of cognitive ability.

Core words are a small number of words that are applicable across place and topic, reducing the complexity of AAC system pages.

Core words are used frequently, while fringe words are used less frequently. Core words are used in multiple contexts and environments. Thus more communicating can be accomplished with fewer words.

Core vocabulary includes a variety of parts of speech, thus including more function words.

Use of core vocabulary AAC systems allows users to gain better understanding of word meanings, gives them greater diversity of messages in a greater variety of contexts, and allows them to focus on language acquisition rather than access. With the stability of location of vocabulary, and limited need for navigation, users can free up the cognitive energy previously needed to learn discriminations.

Sunday, May 24, 2015

Intervention in AAC needs to continue beyond basic core vocabulary building. As with all students who lag in language skills, such skills as syntax development, narrative structure and conversational skills need to be considered.

A variety of strategies have been explored to teach conversational skills to AAC users with severe disabilities, including several that emphasize teaching these skills in natural, genuine settings. Social interactions are important in increasing quality of life, with access to interpersonal relationships, access to curriculum, and access to community resources.

In one intervention, Hunt et al (1988) provided students with AAC conversation books including topical photographs arranged by environment and special events. Systematic instruction in turn-taking skills was then provided, along with typical peers with whom to interact. In addition to increased interaction skills, students’ use of inappropriate behaviors to attract and maintain attention decreased.

Musselwhite and Burkhart provide students with structured instruction in understanding the parts of a conversation and the types of responses used in each. Their Can We Chat program scaffolds conversations using sequenced social scripts for a variety of social interaction purposes. Scripts provide opportunities for social interactions where partners do not need to wait for messages to be constructed or formulated, but where AAC users themselves have the opportunity to create their own messages. Even single switch users can have opportunities to engage in genuine communication that is motivating, self-initiated, and used with a variety of partners.

Westby refers to the “Oral Literate Continuum.” It is crucial for AAC users to develop the ability to tell about an event that happened to them on the way to developing academic discourse skills.

Here is an example of an activity I use in intervention when more practice is needed in generating utterances beyond the single word level. SLPs use lots of pictures in therapy. Download these two pages of picture-based practice for making phrases and sentences. (I bet you thought you were done with snow.)

Friday, May 15, 2015

There are a variety of schools of thought about how to begin to provide intervention and where to begin with AAC.

Many believe that it is necessary to start at the child’s level in order for them to develop functional communication. While there are NO prerequisites to communication, many believe there is a logical order of developmental sequence (with the exception of many practitioners of applied behavior analysis and consistent providers of aided language stimulation). Too often this leads to underestimation of the learner and restraints on the system provided.

1. The research shows that teaching words with a variety of uses and functions for communicating is important for AAC users to become effective communicators. Unfortunately, too often the first thing taught to children with complex communication needs is nouns. The focus is often on meeting basic wants and needs, or avoiding behavioral problems by providing what the child wants to ask for. However, a close look at the child’s environment shows that, for the most part, basic needs and wants are met, and caregivers know what the child wants when it is a concrete or preferred item or activity. As a result, the AAC user ends up being able to label items without being able to tell whether he likes them or not, wants them or not, has a problem with them or not, needs them moved, wants something different instead of them, or had one of them yesterday.

2. The second thing often taught to children with complex communication needs is specific sentence structures, whole message units, and/or specific carrier phrases. The result is that they have little opportunity to learn language structures, little opportunity for spontaneous generation of novel utterances (SNUG), little opportunity to project their own intent upon messages, and that they have artificial sounding speech or voice output.

Some of the first phrases taught to AAC users are “I want,” and “I see.” But how about “I don't want,” “Go away,” “Leave me alone,” “Something different,” “I need a break,” “Need help,” “He’s bugging me,” “Want to go,” or “It mine.”?

3. This growth of language development proceeds in essentially the same path in most typical language learners. It should be the basis for AAC intervention that this path has consistency for all language learners, even while realizing that not all AAC learners will proceed on exactly the same path. While it cannot be predicted in very young children how their language will development, it should be assumed that he will develop language “normally.” Because learners with disabilities may end up with an ever-increasing gap between their current level of language development and that of their peers, it is crucial that intervention not maintain them at a pre-communication skills level.

What else? Effective intervention means providing structured opportunities to communicate, providing these opportunities over and over again, providing these opportunities in multiple contexts, and providing sufficient vocabulary to make these opportunities meaningful.

Now that I have my computer running again and many of my files are actually accessible, I'll be back with new posts. So sorry I missed last week. I still need to reconstruct my computer documents and applications, but at least there is forward movement. Have I said, "I hate technology?" Often.Keep on talking with your aac users.

Sunday, May 3, 2015

Just as language and cognition are intertwined, so are literacy and language interrelated. And so are literacy and augmentative communication skills development interrelated, as well. Literature and literacy can be used to develop and increase language skills, just as language is used to develop literacy skills.

Literacy skills are needed for academic, social and employment success. Literacy is the way in which information is taught in schools. It is, ever-increasingly - the way in which we communicate with each other and maintain social relationships; through email and texting. It is necessary for daily living skills, where we read labels, make lists, and understand directions. Minimal functional literacy skills at least are required for most jobs.

However many AAC users do not acquire literacy skills. Too many are never taught at all. Most students with complex communication needs receive no literacy instruction.

Many teachers are familiar with the Four Blocks literacy program of Pat Cunningham, but not as many special education teachers and speech-language pathologists are as comfortable with using it with their students with special needs.

What is Four Blocks? And how do we apply it to our students?

1. Guided Reading: reading for a purpose

Students learn how to read different texts. The opportunity to read different types of texts increases skills in comprehension. Students learn that reading is not just decoding words, but also gaining meaning. Use guided reading to build vocabulary. Always set a purpose for reading. Use graphic organizers to help organize the elements of the story. Relate what is in the reading to the student's own experiences.

Accommodations:

Create e-books that “read” a modified version of the book and provide additional illustrations for comprehension.

Pre-write choices of facts about the book to share; students can choose one to hold up or “read” when appropriate

2. Self-Selected Reading: learning to select their own reading materials that are interesting. It provides an opportunity to share and respond to reading individually and provides the opportunity to read aloud to children from a wide variety of types of books.

The teacher can read these books out loud, the student can read at his own level, or he can share reading with a peer.

Accommodations:

e-books can be commercial, can be made by upper grade students, and can be found in the library as adapted books.

You can also use trade books at a lower reading level than grade-level.

3. Writing: to develop writing skills

Students share their writings with peers and learn to write with different purposes.

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